LATINO HEALTH DISPARITIES IN HIV/AIDS AND SUBSTANCE USE
As noted in Healthy People 2010 (U.S. DHHS 2000: 13-3), elimination of disparities in the rate of HIV infection, particularly among African American and Latino populations, remains a challenge. Some of the leading causes of illness and death among Latinos indeed include heart disease, cancer, unintentional injuries (accidents), stroke, and diabetes. Latinos, however, are increasingly being affected by the HIV/AIDS epidemic. According to the Center for Disease Control and Prevention (CDC) report in (2001, HIV infection was the leading cause of mortality for 25- 44 years old Latinos. The incidence of AIDS in 2001 was 3 times higher among Latino adults and adolescents than their non-Latino white counterparts. By the end of 2004, an estimated 93,163 Latinos with AIDS had died (CDC 2005). Similar to African Americans, Latinos are disproportionately affected by the HIV/AIDS epidemic. While Latinos constituted approximately 14.2% of the U.S. population in 2004 (U.S. Census Bureau, 2004), they accounted for 20% (8,672) of the 42,514 new AIDS cases diagnosed in that year (CDC 2005) (Fig 2).

The gap between Latinos and other ethnic and racial groups in HIV/AIDS seems to be rising, partly because Latinos have not benefited from medical advances and pre-vention efforts of the 1990s at the same rate as other ethnic and racial groups. Between 2001 and 2004, Latinos had the highest increase in the estimated numbers of persons living with HIV/AIDS (23.8%), compared to African Americans and Whites (20.9%, and 17.7% respectively) (CDC 2005). During this period, the estimated number of AIDS cases also in-creased the most among the Latinos (8.98%), as compared to Whites (5.58%) and African Americans (7.46%) (CDC 2005). Moreover, while the estimated number of deaths of persons with AIDS declined both for Whites (by 18.95%) and African Americans (by 7.28%) during the same period, the number deaths increased by 6.7% for Latinos. The reported cases of HIV/AIDS in infants born to HIV-infected mothers also declined the least among the Latinos (6%), one fifth of the rate for African Americans (30%) and one sixth of that for Whites (36%) between 2000 and 2004 (CDC 2005). Both Latino males and females are disproportionately affected by the HIV/AIDS epidemics. Latino males were over three times as likely to have HIV/AIDS as compared to non-Latino white males, and Latina females were over five times as likely to have AIDS as non-Latina white females in 2004 (CDC 2005). Latino men were also 3.08 times more likely than non-Latino white men to die of AIDS, and Latina women were 5.28 times more likely than non-Latina white women to die of HIV/AIDS in that year. Indeed, HIV/AIDS was the third leading cause of death among Latino males aged 35 to 44 and the fourth leading cause of death among Latina women in the same age group in 2002 (Anderson 2005).

Substance use plays an important role in the spread of HIV epidemic. Sharing injection equipment contaminated with HIV is not the only risk associated with substance use. Both casual and chronic substance users are more likely to engage in high-risk behaviors (i.e., unprotected sex, inconsistent condom use, and having multiple sex partners) when they are under the influence of substances—drugs or alcohol (Beckett, Burman, Collins, Kanouse & Beckman, 2003; Leigh and Stall 1993). Research sponsored by NIDA and the National Institute on Alcohol Abuse and Alcoholism has shown that drug and alcohol use can interfere with judgment about sexual (and other) behavior, thereby affecting the likelihood of engaging in unplanned and unprotected sex. This increases the risk for contracting HIV from infected sex partners.

Moreover, women who use crack cocaine or other non-injection drugs may also be at high risk of sexual transmission of HIV, if they trade sex for drugs (Edlin et al. 1994). Interrelatedness of HIV and substance use risks is supported by the theory of problem-proneness behavior, which asserts that those who engage in one high-risk behavior (for example, initiating sex at an early age) are likely to engage in other risk behaviors (for example, marijuana use) (Koniak-Griffin and Brecht, 1995; Santelli et al., 2001).

Of all the methods of substance abuse, injection drug use (IDU) continues to be a significant risk factor for HIV/AIDS among the Latinos. Latinos in the United States, especially recent immigrants, reuse needles and syringes for vitamin and medication injections and may share their equipment with neighbors and friends (Petersen & Marin, 1988). Injection drug use was reported as the second leading exposure mode for HIV among Latino males (32%) and females (30%) in 2004 (CDC 2005). Indeed, Latino males with HIV/AIDS reported the highest percentage of IDU compared with African Americans (31%) and Whites (18%) (CDC 2005). Within the Latino population, substance abuse affects certain sub-groups more than others. For instance, Puerto Rican males are more likely to contract HIV due to IDU (43%) compared with other Latinos (CDC 2005). Primary cause of HIV among Cuban and Mexican males, however, is male-to-male sexual contact.

In addition to the role of substance use in the spread of HIV/AIDS epidemic, substance abuse itself continues to disproportionately affect the Latino community in the U.S. As indicated by the National Household Survey of Drug Abuse (NHSDA), the rates for illicit drug and alcohol abuse/dependence were the highest among Latinos (7.8%), followed by Whites (7.5%) and African Americans (6.2%) in persons 12 years or older in 2001 (Substance Abuse and Mental Health Service Administration [SAMHSA], 2001). According to the Monitoring the Future study, Latino 8th and 10th graders reported more alcohol, cigarette, and illicit drug use (with the exception of amphetamines) than their non-Hispanic White and African American counterparts (Johnston, O’Malley, Bachman, & Schulenberg, 2006). Latinos also had the highest rate of accidental deaths among drug related deaths (68.3%), compared to whites (50.9%) and African Americans (59%) (NIDA, 2003: 127). Further, Latinos’ visits to emergency departments for drug episode treatment increased by 67% between 1995 and 2002 (SAMSHA, 2002a).

Lastly, there are health disparities between Latinos and other ethnic and racial groups in terms of substance abuse treatment they receive. Based on a national survey funded by the Robert Wood Johnson Foundation Wells (2001) found that Latinos were more likely to be uninsured and had more delays in receiving alcoholism, drug abuse and mental health treatment, lower satisfaction with care, and lower rates of active treatment. Among those with perceived or clinical need, Latinos were the least likely group to be receiving treatment (22.4%) compared with African Americans and Whites (25%, and 37.6%, respectively). In addition, when Latinos do enroll in treatment, they are more likely to dropout. Agosti et al. (1996) found that dropout rates among cocaine abusers in treatment programs were higher among Latinos than among white clients.

There are several reasons underlying Latino health disparities in the U.S., including disparities in HIV/AIDS and substance use. While biological factors play a role in health disparities (Bulatao and Anderson, 2004; Singer and Ryff, 2001), they alone do not explain trends in disparities. Other reasons that need to be considered include socio-economic barriers, lack of health insurance, language barriers, cultural barriers, and access to and quality of health care.